1.03.2011

Over at TNR, John McWhorter has an interesting essay about the effects of the War on Drugs on the black community. In short, he argues that it would be an incredible boon for black people to have drugs legalized across the board. It's an interesting piece, and the comments afterward are worth reading, as well.

For my part, I am broadly in favor of drug legalization. My libertarian streak is strongest when personal behavior is concerned, and I happen to believe that people should have the right to utterly destroy themselves if they want to. If consenting adults want to ravage their bodies with crystal meth, I don't see why it should be society's job to prevent it.

Further, the War on Drugs has been markedly ineffective at preventing access to drugs and the subsequent problems of addition, crime, etc. Having now worked in a wide variety of settings, from the inner city to impoverished rural areas, I can say with a certain degree of confidence that desperate, determined people can get drugs wherever and whenever they want to. I also do not believe that most people who avoid drugs do so because they are illegal, but because they are harmful. Add in the enormous costs in terms of incarcerating drug criminals, fighting cartels in the increasingly violent border areas and beyond, keeping opium profits away from terrorist groups, etc etc etc, it seems to be that the War on Drugs has been far more costly than it was worth.

However, whatever the particular merits (or lack thereof) of McWhorter's argument as it pertains to the black community, the British authority he cites with approval strikes me as insane. McWhorter quotes Bob Ainsworth's address to the House of Commons:

“We need to take effective measures to rob the dealers of their markets and the only way that we can do that is by supplying addicts through the medical profession, through prescription. We cannot afford to be shy about being prepared to do that.”

He continues: “We spend billions of pounds without preventing the wide availability of drugs. It is time to replace our failed war on drugs with a strict system of legal regulation, to make the world a safer, healthier place, especially for our children. We must take the trade away from organised criminals and hand it to the control of doctors and pharmacists.”

This particular doctor wouldn't touch the drug trade with a ten-foot clown pole, thanks all the same. Frankly, I cannot imagine any ethical doctor or pharmacist feeling otherwise.

Let's start with the idea of what medicine is meant to do. It is meant to promote good health and cure disease. Providing users (not just addicts, mind, but users of all stripes) with a means of getting high does neither. One might argue that certain drugs (most commonly marijuana, and also certain psychedelics) are essentially harmless, and some psychiatric research has explored how they may have therapeutic uses. Fair enough, I suppose. But "I'd like to get high" is not a compelling argument for "treatment," or whatever else one might want to call it. And that's to say nothing of the well-described and overwhelming health risks associated with drugs like cocaine, heroin and methamphetamine. The promise to "first, do no harm" goes right out the window, does it not?

Now, perhaps one might argue that doctors should be allowed to prescribe all manner of narcotics legally to people willing to seek treatment for addiction. I have some qualms with this idea, but at least one could plausible squeeze it into the disease/treatment paradigm. But, as I mention earlier, what about all the people who would want to use a little coke this weekend but are loath to call themselves addicts? What possible argument exists in that case? What physician with any scruples would sign up for the role of dealer? And if only addicts can obtain drugs legally from their doctors, how does medicalizing illicit drug use correct the problem of the War on Drugs to begin with?

Further, it seems to me that wherever drugs are dispensed, there's still going to be a high risk of crime. Those places would be ripe for robbery. I have a hard time imagining Rite Aid being willing to risk selling heroin alongside the Dristan, much less the nice family practice down the street.

I suspect that even if drugs somehow were to become legal across the board, they will never be legitimized. People will always need to turn to the seamier elements in society for a fix, because only those parts of society are willing to assume the risks associated with the trade. (Again, this argument does not apply so much to marijuana as to the more addictive, destructive drugs already mentioned.) It seems not only somewhat fitting that such a harmful personal choice should remain in the demimonde, but also the only feasible option.

Posted by
Dan

4 comments:

The whole should physicians be required to provide abortion services issue wasn't an automatic yes, but IIRC there were arguments by reasonable people that yes, physicians ought to be required to offer "socially sanctioned" services. Pharmacists, too. I would expect a similar discussion about professional obligations if the War on Drugs takes this path.

IIRC (I'm a bit under the weather this am) the Netherlands manages the whole provide drugs to junkies thing. Surely the damage if the US tries it will be less than the damage our current choices is causing.

Providing drugs to junkies (which I read as synonymous with "addicts") is one thing. I can see physicians being willing to dispense controlled substances in those circumstances, though I myself am not one of them.

But that still doesn't answer the question of how to deal with people who want to use dangerous, addictive substances on a recreational basis. There is no therapeutic benefit to be gained from providing an ostensibly healthy patient with methamphetamine. It runs counter to the obligations and ethics of medicine.

One can mount an argument that an unwanted pregnancy is a medical condition, and that women seeking it are taking care of their own bodies. (I think that argument begs the question, and am not necessarily endorsing that viewpoint simply by mentioning it.) "I want to get high" is not a medical condition, no matter how you slice it.

What is the therapeutic benefit to modifying a perfectly normal, functioning nose via cosmetic surgery, or adding 2 cup sizes to a set of breasts, other than catering to human desire? If the medical profession can justify the amount of cosmetic surgery performed today, I have no doubt it will find a way to rationalize the ethics of dispensing meth (maybe under the guise of weight loss).

I say this as a reader who has tremendous resepct for your professional ethics, and I in no way disagree with your take on the whole recreational drugs via prescription issue. But as resident gadfly I would be remiss not to point out the camel already comfortably ensconced in the tent, beckoning to the herd outside.

Ah, cosmetic surgery. There are certain circumstances wherein the medical need is clear, such as women who have significant back problems due to breast size, and thus seek breast reduction. Ditto women who are status-post mastectomy. I have also seen patients who have a notably unusual feature that makes them extremely self-conscious, and are genuinely suffering psychologically. In all of these cases, I think the ethical argument is clear.

Now, as far as the "amount" of plastic surgery that is performed in this country and the means by which the performing surgeons get themselves to sleep at night go, I don't have a nickel in that dime. The profession may sanction it, but I personally can't. There's no justifying Heidi Montag, for example. I don't have any opinion about her right to "enhance" (or, perhaps more accurately, disfigure) herself, which I think should be as free as anyone's to snort their brains into oblivion. But I will concede that there is a similar "do no harm" conundrum at play.

I am sure, given the chance to do so, many members of my esteemed profession would avail themselves of the opportunity to make scads of money selling dope to dunces. Call it what they will, however, it will never be medicine.